Rapid mixed-methods assessment of COVID-19 impact on Latinx sexual minority men and Latinx transgender women

Abstract

We conducted a rapid, mixed-methods assessment to understand how COVID-19 affected Latinx sexual minority men (LSMM) and transgender women (LTGW). Using a computer-assisted telephone interviewing software, one interviewer called 52 participants (randomly sampled from a larger HIV prevention pilot study aiming to increase HIV knowledge and testing frequency; n = 36 LSMM and n = 16 LTGW) between 04/27/20-05/18/20. We quantified core domains using the Epidemic-Pandemic Impacts Inventory scale and provided important context through open-ended qualitative questions assessing: 1) COVID-19 infection history and experiences with quarantine; 2) Health and healthcare access; 3) Employment and economic impact of COVID-19. Participants reported increases in physical conflict or verbal arguments with a partner (13.5%) or other adult(s) (19.2%) due to stressors associated with the safer-at-home order. Participants also reported increased alcohol consumption (23.1%), problems with sleep (67.3%) and mental health (78.4%). Further, disruptions in access to Pre-Exposure Prophylaxis or PrEP–a daily pill to prevent HIV–occurred (33.3% of 18 participants who reported being on PrEP). Many said they received less medical attention than usual (34.6%), and LTGW reported delays in critical gender-affirming hormones/procedures. Half of the participants lost their jobs (50.0%); many undocumented participants relayed additional financial concerns because they did not qualify for financial assistance. Though no COVID-19 infections were noted, COVID-19 dramatically impacted other aspects of health and overall wellbeing of LSMM and LTGW. Public health responses should address the stressors faced by LSMM and LTGW during the COVID-19 pandemic and the impact on wellbeing.

COVID-19 Risk and Resilience Among U.S. Transgender and Gender Diverse Populations

“…12 The pandemic has caused cancelations and delays in gender-affirming surgeries for many individuals. 12,13 Additionally, efforts made in health care to prevent COVID-19 transmission, including physical distancing and limited staffing, may delay initiation of hormone therapy 12 and monitoring of its effects. 13 These barriers to gender-affirming care may contribute to increased severity of mental health conditions including depression, anxiety, and psychological distress.…”

“…12,13 Additionally, efforts made in health care to prevent COVID-19 transmission, including physical distancing and limited staffing, may delay initiation of hormone therapy 12 and monitoring of its effects. 13 These barriers to gender-affirming care may contribute to increased severity of mental health conditions including depression, anxiety, and psychological distress. Further, COVID-19-related barriers to accessing medications such as pre-exposure prophylaxis may increase the risk of HIV transmission among TGD people, who bear a disproportionate burden of HIV/sexually transmitted infections compared with the U.S. general population.…”

“…Further, COVID-19-related barriers to accessing medications such as pre-exposure prophylaxis may increase the risk of HIV transmission among TGD people, who bear a disproportionate burden of HIV/sexually transmitted infections compared with the U.S. general population. 13 Moreover, limited access to HIV/sexually transmitted infections testing may cause HIV/sexually transmitted infections to remain undiagnosed and untreated, leading to delays in treatment access, worse clinical outcomes, and HIV transmission risk due to uncontrolled viremia. 13,14 ECONOMIC STABILITY Economic impacts of COVID-19 have been and will likely continue to unduly impact TGD communities.…”

“…13 Moreover, limited access to HIV/sexually transmitted infections testing may cause HIV/sexually transmitted infections to remain undiagnosed and untreated, leading to delays in treatment access, worse clinical outcomes, and HIV transmission risk due to uncontrolled viremia. 13,14 ECONOMIC STABILITY Economic impacts of COVID-19 have been and will likely continue to unduly impact TGD communities. 2 COVID-19 prevention strategies have resulted in closed businesses and increased unemployment, with TGD individuals experiencing job loss at higher rates than cisgender individuals.…”

“…Furthermore, undocumented TGD individuals likely experience additional financial concerns during the pandemic, as Social Security numbers are required for financial assistance via stimulus checks. 13…”